A custom-made device to unlock extracoronal locking-type at tachments Tony Daher, DDS, MSEd,a Nadim Baba, DMD, MSD,b and Steven M. Morgano, DMDc Loma Linda University, School of Dentistry, Loma Linda, Calif; Boston University School of Dental Medicine, Boston, Mass Two of the most common implant complications with the use of attachments are overdenture clip/ attachment loosening (30%) and overdenture clip/attachment fracture (17%).1 These problems are related to the nature of the nylon or plastic clips available for use with implant-retained overdentures. A metal attachment that engages the implant bar (SwissLoc NG; Attachments Intl, Inc, San Mateo, Calif ) (Fig. 1) can also be used in addition to the clips. The use of a locking, plunger-type metal attachment prolongs the useful life of plastic clips. These plunger attachments are commonly placed on the buccal surface of the overdenture flange with a mesial depression in the surrounding acrylic resin to facilitate removal by the patient’s fingernail. This buccal placement is convenient and practical, and will not interfere with esthetics when placed in a mandibular denture. However, when these attachments are placed in a maxillary denture, esthetic concerns and flange thickness commonly prevent their placement on the facial surface of the denture flange, and they are usually placed on the palatal surface of the implant-supported overdenture. Because of the depression in the acrylic
resin, the plunger head may be annoying to the patient’s tongue and can cause tongue soreness (Fig. 2). When the plunger head is at the same level as the surrounding acrylic resin, access to unlock the attachment is not feasible. The purpose of the article is to describe a method of making a device to disengage a palatally placed plunger-type attachment (Fig. 3).
PROCEDURE 1. Make a buccal tunnel corresponding to each attachment plunger by using a drill (ParaPost drill #5 red; Coltène/Whaledent, Inc, Cuyahoga Falls, Ohio) (Fig. 4, A). 2. Remove the head of a toothbrush (Crest; Proctor & Gamble, Cincinnati, Ohio) by using a separating
1 Precision machined SwissLoc NG attachment is extracoronal locking pin/plunger attachment designed to prevent bar-retained implant-supported overdenture from lifting off bar. (Courtesy of Attachments Intl, San Mateo, Calif. Used with permission.)
Presented in part at the annual meeting of the Pacific Coast Society of Prosthodontics, San Francisco, Calif, June 2007. a
Associate Professor, Department of Restorative Dentistry, School of Dentistry, Loma Linda University. Associate Professor, Department of Restorative Dentistry, School of Dentistry, Loma Linda University. c Professor, Director, Division of Postdoctoral Prosthodontics, Department of Restorative Sciences and Biomaterials, Goldman School of Dental Medicine, Boston University. b
(J Prosthet Dent 2008;100:406-407)
The Journal of Prosthetic Dentistry
Daher et al
407
November 2008
2 When attachment is placed in palatal surface of denture base, mesial depression (arrows) in acrylic resin allows plunger head to be noticeable to patient’s tongue, which can produce annoying feeling and sore tongue.
3 Custom-made device.
B
A
4 A, Tunnels (marked in red) are made by using ParaPost drill. B, These holes allow custom attachment disengagement device to be inserted in tunnel to unlock locking pin attachment. This action separates implant connecting bar from implant overdenture. disc (Carborundum Trimmer Disc 10” diameter coarse; Dedeco, Long Eddy, NY). 3. Make a concave area in the toothbrush shank with a carbide bur (E-Cutter H171E; Brasseler USA, Savannah, Ga). 4. Roughen the surface and make 4 divergent holes by using a carbide bur (Midwest FG 702; Dentsply Intl, York, Pa) in a straight handpiece. 5. Make multiple sinusoid bends on a 40-mm-long stainless steel round 0.040” wire (Patterson Dental; St. Paul, Minn) by using pliers (Bird Beak Pliers; Patterson Dental). Leave 10 mm of the straight wire free of sinusoidal bends, and bend it at an angle of 130 degrees (Fig. 3). Place the wire on the concave area of the customized toothbrush. Ensure that one end is inserted inside of the fourth hole for
Daher et al
retention and stability of the wire. 6. Mix and place clear autopolymerizing acrylic resin (Teets Cold Cure Denture Material; Co-Oral-Ite Dental Mfg Co, Diamond Springs, Calif ) in the concave area, and ensure that it engages the 4 holes. Then embed the wire in the acrylic resin. Place the customized toothbrush in hot water under 25 psi of pressure in a pressure pot (Acri-Dense V, pneumatic curing unit; GC America, Alsip, Ill) for 20 minutes. Remove the device and polish it with fine pumice. 7. Adjust the length of the wire to approximately 10 mm and its angle with the toothbrush handle, so it can disengage the attachment (Fig. 4, B). Avoid a wire that is too long because it could dislodge the plunger from its cylinder. Round the extremity of the wire by using a carbide straight hand-
piece bur (H79E; Brasseler USA), and polish it with a rubber polisher (Brown Polisher 1030; Brasseler USA).
REFERENCES 1. Goodacre CJ, Bernal G, Rungcharassaeng K, Kan JY. Clinical complications with implants and implant prostheses. J Prosthet Dent 2003;90:121-32. Corresponding author: Dr Steven M. Morgano Boston University, School of Dental Medicine Division of Postdoctoral Prosthodontics 100 East Newton St, Room G 219 Boston, MA 02118 Fax: 617-638-5434 E-mail:
[email protected] Acknowledgements The authors thank our laboratory technician, Mr George Kerio, for his assistance. Copyright © 2008 by the Editorial Council for The Journal of Prosthetic Dentistry.
